Effects of Recombinant Human Granulocyte/Macrophage Colony-Stimulating Factor on Diabetic Lower Extremity Ulcers: Case Series of Nine Patients

Figures & data

Table 1 Characteristics and Laboratory Findings on Admission

	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6	Case 7	Case 8	Case 9	Reference Range
Age (years)	47	56	52	59	74	69	65	29	80
Sex	Male	Male	Male	Male	Male	Male	Male	Male	Male
BMI	24.61	24.50	27.76	27.08	26.3	25.2	22.2	22.1	27.5
Duration of T2DM (years)	2	2	2	14	16	5	13	3	20
Duration of DFU (days)	14	210	30	15	18	120	28	30	180
Comorbidities
Hypertension	+	+	–	–	–	+	+	–	+
Cardiovascular disease	–	+	–	–	–	+	–	–	–
Stroke	+	–	–	–	–	–	–	–	–
CKD stage	4	5	–	2	3	3	2	2	3
Retinopathy	+	/	+	+	+	/	–	–	–
Laboratory data
WBC (10^9/L)	10.40	2.59	14.18	5.55	8.49	9.40	5.51	6.28	8.48	3.5 ~ 9.5
Hemoglobin (g/L)	132.0	87.0	107.0	143.0	130.0	131.0	134.0	144.0	129.0	130.0~175.0
Platelet (10^9/L)	211.0	88.0	584.0	204.0	265.0	338.0	243.0	277.0	213.0	125.0~350.0
ALT (U/L)	57	19	36	16	12	13	9	9	21	≤ 41
AST (U/L)	30	30	43	12	20	13	10	14	22	≤ 40
LDH (U/L)	222	310	256	162	272	220	172	266	239	135 ~ 225
Cr (µmol/L)	92	199	62	90	116	100	89	51	110	59 ~ 104
eGFR(mL/min/1.73m^2)	57.0	21.2	108.4	79.1	53.1	65.9	78	138.1	54.3	≥ 90
ACR (µg/mg)	2066.4	12,751.2	13.2	13.1	117.5	142.5	9.3	586.6	29.1	< 30
UA (mmol/L)	325.3	142.0	123.0	297.0	448.0	369.0	271.0	334.0	394.0	202.3~416.5
hsCRP (mg/L)	2.1	7.8	78.1	0.9	20.9	11.5	4.7	5.7	2.9	< 1
ESR (mm/H)	27	48	86	10	40	39	23	20	7	0~15
cTnI (pg/mL)	5.0	502.4	1.9	2.0	7.2	4.6	1.9	1.9	8.3	≤ 34.2
NTproBNP (pg/mL)	325	70,000	49	80	/	66	45	/	365.1	< 486
TC (mmol/L)	3.38	3.47	3.78	3.04	3.94	3.85	4.31	5.95	3.98	< 5.18
TG (mmol/L)	1.45	1.12	1.62	1.13	1.08	2.39	1.91	14.23	8.68	< 1.70
HbA1c (%)	7.21	5.70	13.60	5.80	10.00	7.40	10.30	12.70	6.30	4.30 ~ 6.10
Initial ulcer area(cm^2)	4.17	7.38	3.84	3.50	2.50	10.91	6.24	6.74	2.63
Ulcer location	Left first toe	Left heel	Right heel	Left second toe	Sole of right foot	Right lower limb	Dorsum of left foot	Right lower limb	Right first toe
Vascular evaluation
ABI (left)	1.16	1.16	0.96	1.04	1.05	0.98	0.98	1.04	0.75	0.91 ~ 1.30
ABI (right)	1.19	1.15	1.23	1.25	1.18	1.04	1.06	1.01	0.50
Wound evaluation
SINBAD	3	4	4	2	3	3	3	3	3
Wagner	1	1	3	1	2	3	2	2	1
PEDIS	2	2	3	2	2	3	2	3	2
Neuropathic ulcer	+	+	+	+	+	/	+	–	+
Secretion culture	Pseudomonas aeruginosa	Normal skin flora	Klebsiella pneumoniae	Acinetobacter baumannii	Staphylococcus aureus	Staphylococcus aureus	Coagulase negative staphylococcus	Staphylococcus aureus	Candida parapsilosis
Antibiotics	Moxifloxacin Hydrochloride	Ceftriaxone	Biapenem	Sulbactam /Cefoperazone	Linezolid	Teicoplanin, Sulbactam /Cefoperazone	Ceftriaxone	Teicoplanin	Piperacillin Sodium and Tazobactam Sodium

Notes: +, yes; -, no; /, not available.

Abbreviations: ABI, ankle brachial index; ACR, albumin-to-creatinine ratio; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; Cr, creatine; hsCRP, high-sensitivity C-reactive protein; cTnI, cardiac troponin I; DFU, diabetic foot ulcer; eGFR, estimated glomerular filtration rate; ESR, erythrocyte sedimentation rate; HbA1c, Hemoglobin A1c; LDH, lactate dehydrogenase; L-PRF; leukocyte-and platelet-rich fibrin; NTproBNP, N-terminal pro-b-type natriuretic peptide; T2DM, type 2 diabetes mellitus; TC, total cholesterol; TG, triglyceride; UA, urine acid; WBC, white blood cell.

Figure 1 Representative images of the healing process in case 1.

Figure 2 Representative images of the healing process in case 2.

Figure 3 Representative images of the healing process in case 3.

Figure 4 Representative images of the healing process in case 4.

Figure 5 Representative images of the healing process in case 5.

Figure 6 Representative images of the healing process in case 6.

Figure 7 Representative images of the healing process in case 7.

Figure 8 Representative images of the healing process in case 8.

Figure 9 Representative images of the healing process in case 9.

Figure 10 Wound size of all 9 patients during rhGM-CSF treatment.

Figure 11 Relative area size during rhGM-CSF treatment. Data were shown as the percentage of initial ulcer area.